Provider Demographics
NPI:1356982946
Name:MARTIN, RACHEL LYNN
Entity type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:LYNN
Last Name:MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:KURTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:120 FRIENDSHIP LN
Mailing Address - Street 2:
Mailing Address - City:BEEBE
Mailing Address - State:AR
Mailing Address - Zip Code:72012
Mailing Address - Country:US
Mailing Address - Phone:501-288-0185
Mailing Address - Fax:
Practice Address - Street 1:120 FRIENDSHIP LN
Practice Address - Street 2:
Practice Address - City:BEEBE
Practice Address - State:AR
Practice Address - Zip Code:72012
Practice Address - Country:US
Practice Address - Phone:501-288-0185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-04
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider